Jonsson, Anders

Silverplats, Katarina

Abstract [en]

Background Exsanguination from extremity wounds is a major cause of potentially preventable deaths in the military environment. With the widespread use of different techniques to control this type of bleeding, such as tourniquets and haemostatic agents, it has now become possible to dramatically improve the survival rate for these casualties. Objective Varying techniques for pre-deployment training of haemorrhage control have been tested and used by the Swedish Armed Forces, for example different types of patient simulators. The recently developed military trauma patient simulators have for example become a major improvement for the training of standard tourniquet application. However, very proximal ‘junctional’ bleedings located in for example axillae and groins still represent a special training problem, since tourniquets cannot be used on these locations. Methods Based upon an idea presented by Moorhouse et al.*, we have developed a hybrid training model, consisting of a modified Laerdal® SimMan® 2G manikin, with a slab of meat with artificial ‘vessels’ running through the base of a series of wounds. Artificial blood under pressure is used to produce a bleeding effect. Results This hybrid model has been used for two years in the training of medics and combat life savers. It represents a realistic bleeding model, which can be used over and over again. Also, the cost for training is low compared to other alternatives. Conclusions Existing patient simulators are not suitable for training of haemorrhage control on proximal extremity locations. Live tissue training on anaesthetized animals is not a first alternative for this kind of training. We consider the proposed hybrid simulation model as the best training method so far.